Addressing Trauma and Substance Abuse with Peer-Led Programs

People who experience trauma, either as children or later in life as adults, are at a higher risk of developing mental health and substance use problems and chronic physical health conditions. Exposure to childhood trauma includes physical, emotional abuse, and sexual abuse; violence; neglect; family instability and divorce. Trauma later in life includes many similar events as well as car accidents, workplace violence or accidents, terrorism, military first responders, and military service (indeed, the original focus on psychological trauma arose in relation to military trauma during the World Wars). Trauma can lower people’s sense of security and safety, and challenge their resiliency. Optum and Treatment Innovations recognize that trauma is often an important component of behavioral and physical health and offer programs that support well-being and resiliency.

Seeking Safety ( was developed by Lisa Najavits, PhD to help people with trauma and/or substance problems. It is an evidence-based model with over 20 outcome studies and is listed on the Substance Abuse and Mental Health Service Administration’s (SAMHSA) National Registry of Evidence-based Programs and Practices. It is a present-focused, coping skills model designed for flexible use: in group or individual settings, for both male and female clients, in any level of care (e.g., outpatient, inpatient, residential), and can be delivered by any staff regardless of licensure, degree, or training. Recently Najavits and colleagues published the first article on peer-led Seeking Safety (Najavits, et al., 2014), showing positive results when conducted entirely by peers in a Florida program. Seeking Safety is published as a book (Najavits, 2002) that includes all of the client handouts as well as the leader guide.

In ten states Optum has implemented Seeking Safety programs for individuals who experienced trauma and may also have substance use and posttraumatic stress disorder (PTSD). Optum has worked with local community-based, consumer-led peer organizations to develop and implement this program as a service to be provided by peer specialists. Optum has trained over seventy of these specialists. There has been favorable response from those who have been trained and are delivering these services, as well as the recipients.

Seeking Safety is a structured model to help keep each session safe and focused on present-day coping skills. Per the Seeking Safety book, each session follows a session format that includes a check-in; reading a quotation that is relevant to the topic of the session, relating the material to participants’ lives; and a check-out. Each Seeking Safety topic is an inspiring coping skill relevant to both trauma and substance problems (although participants do not have to have problems in both areas). Topics include Safety, Taking Good Care of Yourself, Compassion, Coping with Triggers, Asking for Help, Setting Boundaries in Relationships, and Honesty. There are 25 Seeking Safety topics, but they can be done in any order and as few or many as time allows. The model has been found to be extremely safe across over 20 years of implementation in highly diverse settings with diverse clients, clinicians, and programs. It has been translated into nine languages and is one of the lowest cost models available (training is available per, but is not required).

The Seeking Safety program was designed to enable those who experienced trauma and have behavioral health conditions to develop skills and strategies to help them live healthier and fulfilling lives. Peer-led Seeking Safety expands the reach of the model by offering ways to help peers help others. The core concepts of Seeking Safety encourage people who suffered trauma to stay safe; respect themselves; use coping techniques (not substances) to deal with emotional pain; make the present and future better than the past; learn to trust; take good care of their body; get help from safe people; heal fully from PTSD, and become substance-free — living by the adage that if one method doesn’t work, try something else… and, never, never, give up.


Najavits, L., Hamilton, N., Miller, N., Doherty, J., Welsh, T., & Vargo, M. (2014). Peer-led Seeking Safety: results of a pilot outcome study with relevance to public health. Journal of Psychoactive Drugs, 46(4), 295-302.

Najavits, L. M. (2002). Seeking Safety: A Treatment Manual for PTSD and Substance

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